Therapeutic Inertia for Glycaemic and Cardiovascular Risk Factor Control in Patients with Type 2 Diabetes: A Real-world Electronic Medical Records Based Study

Research Opportunity
Number of Honour Places Available
Medicine and Radiology
Royal Melbourne Hospital
Primary Supervisor Email Number Webpage
Professor Sanjoy Paul

Project Details

Diabetes mellitus is one of international health priority areas, with about 8.3% of adults worldwide estimated to have type 2 diabetes (T2DM).  Guidelines for treatment of T2DM suggest maintaining tight risk factor control by active titration of combinations of medication, as well as making changes to lifestyle as appropriate. However, the international community has recently been concerned about the failure or delay in providing appropriate treatment intensification for managing glycaemic and cardiovascular risk factors in younger adult patients (therapeutic inertia). To date, no study has evaluated – in large, nationally representative populations – how frequently appropriate intensification of treatment is “delayed” or “missed entirely” when simultaneously managing cardiovascular and glycaemic risk factors.

This PhD project is designed to conduct a series of pharmaco-epidemiological studies to explore the prevalence, predictors and outcomes of therapeutic inertia in patients with T2DM using the UK primary care longitudinal database (n~432,000, median follow-up ~ 12 years). This project also creates a unique opportunity to address methodological issues in the extraction and management of population-level “Big Data”.

In adults with and without a history of CVD and chronic kidney disease, the specific aims are to:

Ø 1. Evaluate the temporal patterns of prescriptions and therapy intensification for anti-diabetic and cardio-protective medications;

Ø 2. Determine the prevalence of TI for control of glycaemic (HbA1c) and cardiovascular (blood pressure and lipids) related risk factors;

Ø 3. Identify the patient- and practice-level predictors of TI for control of glycaemic and cardiovascular related risk factors;

Ø Evaluate the possible association of TI with long-term cardiovascular events (CVE) and all-cause mortality.


A comprehensive understanding of the extent, predictors and associated consequences of failure to follow relevant guidelines, in terms of under treatment, will assist in delivering high-quality care at an individual and population level. Knowledge of how and when care fails to meet appropriate targets is essential to developing systems that can overcome the current barriers to achieving high-quality care.

Selection Criteria:

· MSc in Statistics, Health Informatics, Clinical Epidemiology, or related disciplines.

· Strong statistical methodological background.

· Excellent programming skills (SAS, R, Python, C++) and experience in working with relational databases (SQL).

· Excellent written and oral communication skills.

· Interest to develop research career in clinical biostatistics / epidemiology, especially in chronic and mental diseases.

· Strong motivation to conduct independent research in the field of clinical biostatistics.

· Ability to work in collaborative environment with local and international researchers.


Interested applicants may contact Professor Sanjoy Paul, Director of Melbourne EpiCentre and the Principal Investigator in this project. Email:

School Research Themes


Research Opportunities

Students who are interested in joining this project will need to consider their elegibility as well as other requirements before contacting the supervisor of this research

Graduate Research application

Honours application

Key Contact

For further information about this research, please contact a supervisor.


Medicine and Radiology

Research Group / Unit / Centre

Melbourne EpiCentre

Research Node

Royal Melbourne Hospital

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